Written by Stephen M. Edelson, Ph.D.
Center for the Study of Autism, Salem, Oregon
Toe walking is quite common in young children,
age three and younger; but toe walking, especially in children five
years and older, is often associated with neurological immaturity.
Many parents and professionals are not aware of the various interventions
used to treat toe walking. The following interventions are listed
from least to most invasive.
1) Physical exercises are sometimes used to stretch
out the tendon in order to reduce toe walking, but this treatment
has had minimal success.
2) A dysfunctional vestibular system, a common
problem in autism,
may be responsible for toe walking. The vestibular system provides
the brain with feedback regarding body motion and position. It may
be possible to reduce or eliminate toe walking by providing the
person with therapeutic vestibular stimulation (e.g., being swung
on a glider swing).
3) Toe walking may be directly or indirectly related
to a visual-vestibular problem. I have conducted several research
studies with Melvin Kaplan, O.D. at the Center for Visual Management
in Tarrytown, New York. While conducting these studies, I observed
four individuals who were toe walkers. In each case, their toe walking
was eliminated within seconds after the child began wearing prism
Description of program. Prism lenses displace
the person’s field of vision up, down, left or right. Dr. Kaplan
and other developmental optometrists have developed nonverbal assessment
procedures to determine the correct direction and degree of displacement
for the prism lenses. Unlike other interventions for autism, changes
in attention and behavior are observable immediately after the person
begins to wear the lenses. The use of prism lenses is part of a
‘vision training’ program. The program typically lasts for one year
and involves wearing prism lenses and performing daily visual-motor
exercises. After the program is completed, the person no longer
needs to wear the prism lenses.
(4 & 5) Casting is another intervention used
to stop toe walking. This procedure involves wearing a cast to stretch
out the tendon. In most cases, the cast is applied every two weeks
for a total of 6 to 8 weeks. Another treatment involves surgery.
Long-leg casts are then worn for six weeks and followed by night
splinting for several months.
It is important for parents to learn as much as
possible about treating toe walking before selecting an appropriate
intervention for their child. When making a decision about any treatment,
parents should take into account the treatment’s effectiveness,
safety and cost.
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